Orszag suggested that others who have questioned the bill haven’t been as thorough as Brownstein. He noted that The Atlantic reporter identified specific pages of the bill while interviewing him for the piece.

“I would say to folks in the looser range, ‘What specifically else would you do?’” he added.

This must be a joke. Ron Brownstein’s pathetic article was “thorough” because he listed page numbers and he talked to the experts Orszag wanted him to talk to. But a critical reading of the piece reveals that Brownstein knows almost nothing about health care.

It is one thing that the Obama administration decided not to try to pursue many proven cost-cutting solutions because they are too politically difficult. I understand you need to pick your battles, and governing is the art of the possible. But pretending these proven cost-controlling ideas don’t even exist is governmental malpractice.

A minimum medical loss ratio for insurance companies mandating that they spend at least 90 cents of every dollar they take in as premiums on health care. This is based on the crazy idea that health insurance should insure people’s health instead of corporate profits.

Turn all health insurances companies into non-profits. Most countries that are not single payer (Switzerland, Germany, Belgium) require all basic health insurance plans to be non-profits.

On the new exchanges, create a much stronger risk adjustment mechanism, like in the Netherlands, to encourage competition on quality and cost effectiveness, instead of the cherry picking of healthy customers.

Allow undocumented immigrants to buy health insurance on the new exchange with their own money. It will increase the size of the risk pool and reduce the cost of uncompensated care in this country.

On the new exchanges, use more tightly defined benefit packages, and define plan levels based on deductible and copay size, instead of actuarial value. This will simplify comparison shopping and encourage the selection of more cost-effective HMO’s, instead of PPO’s

Allow for drug re-importation. People in every other first world country pay much less for the same prescription drugs. Let Americans buy these cheaper drugs from Canada or Europe.

Allow Medicare to directly negotiate lower drug prices. Medicare Part D was one of the biggest corporate giveaways in American history. Allow Medicare to use its size (as the VA system does) to directly negotiate for lower drug prices for seniors.

Eliminate direct-to-consumer drug advertising. It only increases the unnecessary use of medicine.

Follow the FTC recommendation by providing shorter exclusivity periods for biosimilars. The current bills create an extremely long 12-year exclusivity period. Going with the FTC recommendations will increase the availability of much cheaper generic versions of life saving biologics.

Create a robust public option that can use Medicare rates and Medicare’s provider network.

Create a single provider reimbursement negotiator like basically every other industrialized nation. The lack of this is the single biggest reason why, as a nation, we pay several times what other countries do for the same procedure.

Create a fully integrated, government-run health care HMO, based on the VA health care system, which would be an insurance option for all Americans.

Finally, adopt a Medicare-for-all single-payer system for everyone in the country.

These ideas are not radical or untested. All of them (except the exclusionary period for biosimilars) are being used in this country and/or other countries to reduce cost. These are all proven cost control solutions. Implementing all or most of these ideas would save our country trillions on health care over the next decade.

I know the Obama administration is aware of these cost saving ideas because several of them (drug reimportation, direct medicare drug price negotiation, robust public option) were part of his campaign’s health care plan. Obama traded away most of these cost saving reforms to PhRMA and other industry lobbies in exchange for campaign ads. If you trade away most of the cost controlling reforms to bring the different industries on board, you have no right to go around complaining when people say your reform plan does not do enough to control cost.

Just like so many of obama’s top people, orszag is in the big corps’s pocket. We might as well have allowed w to run again and steal a third election; we probably would be at about the same place. I wish that I had Jane’s optimism. I would like to see her elected to the House or Senate, but she is probably in the best place now by keeping all of the good people here as this post shows.

THIS is why that Daily Kos poll shows lack of voting enthusiasm for 2010 — at least for me. The Dems always have to sacrifice most of what they want for the greater “good” of a few — while at other times when out of power, giving into of most of what the GOP wants without getting anything in return.

I believe what Peter meant to say is, “Our critics don’t have any ideas for controlling costs other than the ones that we decided would be off the table before the debate even began. And if they do, those are off the table too.”

At least the balled faced lying crooked war criminal made up his bloody mind about something (anything) The present CEO has not an ounce of balls. As Helen Thomas says he is scared to make a a decision.

If Oh Bummah! sends any more troops to Afghanistan or Iraq he may as well kiss his ass goodbye in 2012 and the dems can kiss their collective asses in 2010 if no comprehensive health care bill passes in Congress.

Fer Gawds F**K. Some asshat from some Defense think tank just passed off the bomb on NPR this morning that “If Obama uses the words “Exit Strategy” in reference to Afghanistan he’ll be a one-term President.” And he need to “get his “base” in line”. That he would be sending 30,000 which is the minimum that McChrystal asked for which “is not enough”.

Did Scott Simon ask the guy to defend any of these statements? No…! But the dope did admit that the big problem is not with defeating the Taliban…it’s with Karzai’s government, corruption, and the fact that you can kill off Taliban but more will constantly emerge if the fundamental economic and social problems of Afghanistan are not resolved. But did he give any idea as to HOW these would be resolved? Not a smidgen.

And to the essay above…Brownstein likely had specific page references in the Health Bill not because HE had read it…but because lobbyists had supplied him with them…and the accompanying questions.

Allow Medicare to directly negotiate lower drug prices. Medicare Part D was one of the biggest corporate giveaways in American history. Allow Medicare to use its size (as the VA system does) to directly negotiate for lower drug prices for seniors.

The size of the VA doesn’t seem to be why it can negotiate such low drug prices; as it is almost one-tenth the size of the pool of 70+ Million insured by UnitedHealth, which doesn’t enjoy the same efficiencies.

Best practices standards for say the 12 most common presentations that lead to hospitalization.

Eliminate redundant testing. An ultrasound for example is a lower cost, lower risk, better diagnostic tool for something like gallstones. Yet CTs are often done as well for this. A CT should only be done if there was a problem with the ultrasound. Eliminate overtesting too. I knew a neurologist that would automatically order a barrage of super-expensive tests everytime he was consulted

Use a single standardized claim form

Incentivize for a more rational redistribution of healthcare resources. Some communities have two or more hospitals with lots of redundancy (and inefficiencies) between them. At the same time other aspects of healthcare are underserved.

I would also stress the importance of educating the public on their bodies and on the most common disease processes. It still amazes me how many smart, well informed people are completely clueless when even simple medical issues arise.

More and more one is left desiring 2008 Barack Obama and loathing 2009 Barack Obama.

JWs 1 – 13 listing is spot on. Incredible to think Obama WH wants to ignore such large amounts of right policy and right long term outcome.

Do not much care anymore if the Rs or Ds are running WashingtonDC as both parties are falling short too much too often. The politics need to improve. The policy choices need to improve. The performance on campaign premises needs to stay within the 90 – 95 % completion range on effectiveness and competence. If the Rs and Ds can not cut it then they need to go away. The problems are not going away and a few more runs like Junior Bushs or with what appears to be growing shortfalls on policy and execution with this Obama WH are not R or D related. Americans need better Americans running things better in WashingtonDC. The errors and incompetence are killing America. Mediocrity is killing America.

There are 535 Americans in Congress. Far too many are Bozos or Simpletons.

One American gets to be President four years at a time. Whatever BO was selling during 2008 sure as hell is not what he is doing thus far in WH.

This 2009 healthcare reform is a debacle.

Better nothing then this target miss.

Barack Obama took Single Payer off the table. He should suffer for doing so. Whoever advised or laid out this Obama WH healthcare reform strategy idea should be banished from Obama WH. JW lays it out clearly enough above as to why. Barack Obama seems to be a smart man. Is he wise? Wondering.

JW hits the point above well enough. Why the hell was Obama WH not able to? Or unwilling to? There should be real consequence for this failure.

Regarding suggestion #8, about banning direct-to-customer advertising of medicines: This not only increases the unnecessary use of medicine, those commercials and magazine-filling glossy advertisements also cost money — thereby increasing the cost of those medicines for the people convinced to ‘ask their doctors if X is right for them’ — as well as for everyone else who actually needs those medicines.

Nice work Jon. And a memo to Orszag and the Obama Adminstration—part of being in American politics is taking risk. If you think you have some magical ability to get what you want with no downside you are delusional. Risk IS part of the game. The public is growing tired of your high flying platitudes called good intentions that you freely compromise away because of political cowardice. Either have the courage to stand up for something redemptive or stand aside and let those with genuine integrity lead the way.

Control health care costs? Cut the salaries of doctors earning more than $200,000/year in half. Same for greedy hospital administrators. Funny, no one wants to talk about the obscenely high salaries in the medical profession as a major contributor to the high costs of health care in America…

The money physician’s make is one of the elephants in the room. How about this? Every physician knows how to do basic medical care; what if every physician, psychologist, and dentist who graduated from a public school, wherein the taxpayer footed the bill for half their graduate education, was required to provide services to Medicare and Medicaid patients? For a physician, say forty elderly people. Half a day twice a month. Seems fair to me.

In a conference call, Peter Orszag suggested that others who have questioned the bill haven’t been as thorough as Brownstein. He noted that The Atlantic reporter identified specific pages of the bill while interviewing him for the piece.
“I would say to folks in the looser range, ‘What specifically else would you do?’” he added.
Here’s what I’d do.
1. A minimum medical loss ratio for insurance companies mandating that they spend at least 90 cents of every dollar they take in as premiums on health care. This is based on the crazy idea that health insurance should insure people’s health instead of corporate profits.
2. Turn all health insurances companies into non-profits. Most countries that are not single payer (Switzerland, Germany, Belgium) require all basic health insurance plans to be non-profits.
3. On the new exchanges, create a much stronger risk adjustment mechanism, like in the Netherlands, to encourage competition on quality and cost effectiveness, instead of the cherry picking of healthy customers.
4. Allow undocumented immigrants to buy health insurance on the new exchange with their own money. It will increase the size of the risk pool and reduce the cost of uncompensated care in this country.
5. On the new exchanges, use more tightly defined benefit packages, and define plan levels based on deductible and copay size, instead of actuarial value. This will simplify comparison shopping and encourage the selection of more cost-effective HMO’s, instead of PPO’s
6. Allow for drug re-importation. People in every other first world country pay much less for the same prescription drugs. Let Americans buy these cheaper drugs from Canada or Europe.
7. Allow Medicare to directly negotiate lower drug prices. Medicare Part D was one of the biggest corporate giveaways in American history. Allow Medicare to use its size (as the VA system does) to directly negotiate for lower drug prices for seniors.
8. Eliminate direct-to-consumer drug advertising. It only increases the unnecessary use of medicine.
9. Follow the FTC recommendation by providing shorter exclusivity periods for biosimilars. The current bills create an extremely long 12-year exclusivity period. Going with the FTC recommendations will increase the availability of much cheaper generic versions of life saving biologics.
10. Create a robust public option that can use Medicare rates and Medicare’s provider network.
11. Create a single provider reimbursement negotiator like basically every other industrialized nation. The lack of this is the single biggest reason why, as a nation, we pay several times what other countries do for the same procedure.
12. Create a fully integrated, government-run health care HMO, based on the VA health care system, which would be an insurance option for all Americans.
13. Finally, adopt a Medicare-for-all single-payer system for everyone in the country.
If you need more help, please advise.

Thanks for the good suggestion to ban corporation-to-consumer direct ads for prescription drugs. Recently, I subscribed to the Saturday Evening Post magazine, thinking that it would be an echo of the old magazine with the Norman Rockwell Americana paintings that graced its covers. Nooo, it was chuck full of full-page ads for toxic prescription drugs, with the back page listing all the contraindications and toxicities. Very depressing. I called up and canceled my subscription and suggested that they produce a nice magazine without any ads, along the lines of Birds and Blooms…

Orzag? The same old, same old. I know we were promised CHANGE, but it sure looks like we’re not going to get it.

Corporate America has everyone in their pockets, and unlike Obama’s promises we see the same DOJ hacks, the same compromising at the beginning not at the end, incompetence and a lack of transparency on all levels. Obama is a decidedly detached and cautious man unlike the warrior we expected him to be. On Healthcare he has fumbled and remained aloof with the excuse that he didn’t want a repetition of Clinton’s failure. But that is not the case. He has refused to lead and pave the way. He has not been bold or clear with the public in selling Healthcare Reform & the PO.

Without a Public Option there is no point to a bill which creates yet more victims delivered to private insurance, and offers no recourse to find competitively priced insurance. And, oh yes, Obama made a backroom deal with Billy Tauzin head honcho Lobbyist of Big Pharma that they give 80 billion over 10 yrs from Drug monopoly with the caveat that they will not advertise against Obama’s Healthcare Bill.

This alone is disgraceful as the Drug companies made 77 billion in profits last year, so this is a juicy deal for BigPharma. Medicare RX Plan D
with its donut hole remains the same, so seniors continue to get rolled over.

Last but not least women have again been cynically used for political opportunism with the Stupak Amendment in House bill that takes women back to the wilderness. Abortions will be all but impossible except for the wealthy and connected. Pelosi is a traitor to her class, and Obama finds it useful to allow the Catholic Church to dictate to our legislators. Apparently all the Democrats think this is ok if it’s necessary to pass this bill. What sleaze.

Women will not be forgetting this humiliating betrayal that removes one of the basic rights fought for so hard for decades….The right to choose.

Orszag sounds like he saw what happened to a certain White House Counsel and has decided that the best way to keep his job of to shift over into “Whatever Rahm Wants” mode. It’s depressing.

In the Bush Admin, we had Cheney, Rummy and Turdblossom. We swept them out for Rahm, Summers and Axlerod. Admittedly the Bush folks were vastly more Evil. But our trio are on their way to doing as much to destroy our party as those three did to destroy the GOP.

Strongly disagree, all they do is work on getting elected. We need more voters who vote based on performance and not parties. I don’t care if they are Democrats or Republicans as long as they fight for the issues I’m passionate about, and don’t screw up the stuff I don’t have time to pay attention to.

The current Democratic majority renewed the Patriot Suppression of Liberties Act, rubber stamped additional War Funding, and are selling out Health reform. As a Majority Party all year, the Democrats have been saying to the Republicans “let’s do it your way” and the Republicans say “no.” Of course the Republicans don’t have to participate because they have the Democrats to push their agenda for them.

We don’t need better pols, we need an entirely new slate of candidates committed to serving the People as a first priority, and an electorate willing to require it.

I am insufficiently satisfied with President Obama to vote for him again for any positive reason. But there are some advantages over the previous guy.
1-He is showing up for work.
2-He dosen’t embarrass me as an American
3-He’s a reader
4-He made at least one good Supreme Court nomination
5-He’s down with that Science thing